A Comparative Study Evaluating the Incidence of Colorectal Neoplasia(s) in Candidates for Bariatric Surgery by Screening Colonoscopy, 40–49 Versus 50–65 Years Old: a Preliminary Study



Obesity and metabolic syndrome (MetS) are associated with colorectal neoplasia (CRN) and carcinoma (CRC). Whether such subjects must undergo screening colonoscopy (SC) earlier, is unknown. Incidences of CRNs in 40–49- versus 50–65-year-old bariatric patients were compared by SC. No prospective data on SC is available in morbidly obese/MetS.

Material and Methods

Surgical weight loss candidates over 39 years of age, asymptomatic, and average-risk for CRC offered SC. Those giving written informed consent were enrolled. Colonoscopies were done by the same surgeon. Smoking/drinking history, fasting blood glucose (FBG), insulin, C-peptide, triglyceride, high density lipoprotein, vitamin D, HbA1c, and insulin resistance parameters were recorded. CRN rate and the distribution of variables in patients 40–49 years of age were compared with 50–65. Student’s t and Chi-square tests were used as appropriate. P < 0.05 was regarded as statistically significant.


Among 168 SCs, 47 had CRNs (27.9%). Including carcinoma, 15 had an advanced CRN (aCRN) (8.9% aCRN and 0.6% CRC). CRN rate was 35.6% in ≥ 50 years old whereas 22.1% in 40–49 (p = 0.053). aCRN rates (8.4% in 40–49 versus 9.6% in 50–65) were similar (p = 0.792). Metabolic parameters and smoking-drinking history were equally distributed between the groups except FBG and HbA1c as their mean levels were slightly higher in the 50–65 age group (p < 0.05).


Presented results warrant routine SC in the 40–49-year-old morbidly obese and/or MetS patient population with average risk, and in aged > 50, it certainly must be enforced and included in the preoperative check-list if not done before.

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  1. 1.

    Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.

    Article  Google Scholar 

  2. 2.

    Ben Q, An W, Jiang Y, et al. Body mass index increases risk for colorectal adenomas based on meta-analysis. Gastroenterology. 2012;142:762–72.

    Article  Google Scholar 

  3. 3.

    Omata F, Deshpande GA, Ohde S, et al. The association between obesity and colorectal adenoma: systematic review and meta-analysis. Scand J Gastroenterol. 2013;48:136–46.

    Article  Google Scholar 

  4. 4.

    Kim NH, Park JH, Park DI, et al. Metabolic syndrome is a risk factor for adenoma occurrence at surveillance colonoscopy. A single-center experience in Korea. Medicine. 2016;95:e4454.

    CAS  Article  Google Scholar 

  5. 5.

    Hu NC, Chen JD, Lin YM, et al. Stepwise relationship between components of metabolic syndrome and risk of colorectal adenoma in a Taiwanese population receiving screening colonoscopy. J Formos Med Assoc. 2011;110:100–8.

    Article  Google Scholar 

  6. 6.

    Vu HT, Ufere N, Yan Y, et al. Diabetes mellitus increases risk for colorectal adenomas in younger patients. World J Gastroenterol. 2014;20:6946–52.

    Article  Google Scholar 

  7. 7.

    Yoon YS, Keum N, Zhang X, et al. Hyperinsulinemia, insulin resistance and colorectal adenomas: a meta-analysis. Metabolism. 2015;64:1324–33.

    CAS  Article  Google Scholar 

  8. 8.

    Colangelo LA, Gapstur SM, Gann PH, et al. Colorectal cancer mortality and factors related to the insulin resistance syndrome. Cancer Epidemiol Biomark Prev. 2002;11:385–91.

    Google Scholar 

  9. 9.

    Ahmed RL, Schmitz KH, Anderson KE, et al. The metabolic syndrome and risk of incident colorectal cancer. Cancer. 2006;107:28–36.

    Article  Google Scholar 

  10. 10.

    Stürmer T, Buring JE, Lee IM, et al. Metabolic abnormalities and risk for colorectal cancer in the physicians’ health study. Cancer Epidemiol Biomark Prev. 2006;15:2391–7.

    Article  Google Scholar 

  11. 11.

    Bowers K, Albanes D, Limburg P, et al. A prospective study of anthropometric and clinical measurements associated with insulin resistance syndrome and colorectal cancer in male smokers. Am J Epidemiol. 2006;164:652–64.

    Article  Google Scholar 

  12. 12.

    Trevisan M, Liu J, Muti P, et al. Markers of insulin resistance and colorectal cancer mortality. Cancer Epidemiol Biomark Prev. 2001;10:937–41.

    CAS  Google Scholar 

  13. 13.

    Stocks T, Lukanova A, Johansson M, et al. Components of metabolic syndrome and colorectal cancer risk; a prospective study. Int J Obesity. 2008;32:304–14.

    CAS  Article  Google Scholar 

  14. 14.

    Sung JJ, Ng SC, Chan FK, et al. An updated Asia Pacific consensus recommendations on colorectal cancer screening. Gut. 2015;64:121–32.

    Article  Google Scholar 

  15. 15.

    Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. multi-society task force on colorectal cancer. Am J Gastroenterol. 2017;112:1016–30.

    Article  Google Scholar 

  16. 16.

    Lee BI, Hong SP, Kim SE, et al. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc. 2012;45:25–43.

    Article  Google Scholar 

  17. 17.

    The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc. 2003;58(Suppl 6):S3–43.

  18. 18.

    Lin OS, Kozarek RA, Cha JM. Impact of sigmoidoscopy and colonoscopy on colorectal cancer incidence and mortality: an evidence-based review of published prospective and retrospective studies. Intest Res. 2014;12:268–74.

    Article  Google Scholar 

  19. 19.

    Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.

    CAS  Article  Google Scholar 

  20. 20.

    Botteri E, Iodice S, Bagnardi V, et al. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300:2765–78.

    CAS  Article  Google Scholar 

  21. 21.

    Regula J, Rupinski M, Kraszewska E, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355:1863–72.

    CAS  Article  Google Scholar 

  22. 22.

    Hong SN, Kim JH, Choe WH, et al. Prevalence and risk of colorectal neoplasms in asymptomatic, average-risk screenees 40 to 49 years of age. Gastrointest Endosc. 2010;72:480–9.

    Article  Google Scholar 

  23. 23.

    Imperiale TF, Wagner DR, Lin CY, et al. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med. 2002;346:1781–5.

    Article  Google Scholar 

  24. 24.

    Strul H, Kariv R, Leshno M, et al. The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40-80 years. Am J Gastroenterol. 2006;101:255–62.

    Article  Google Scholar 

  25. 25.

    Eisele R, Vogelsang E, Kraft K, et al. Screening for colorectal lesions with high-resolution video colonoscopes in a German male average-risk population at 40 to 59 years of age. Z Gastroenterol. 2007;45:952–7.

    CAS  Article  Google Scholar 

  26. 26.

    Rundle AG, Lebwohl B, Vogel R, et al. Colonoscopic screening in average risk individuals ages 40 to 49 versus 50 to 59 years. Gastroenterology. 2008;134:1311–5.

    Article  Google Scholar 

  27. 27.

    Boursi B, Halak A, Umansky M, et al. Colonoscopic screening of an average-risk population for colorectal neoplasia. Endoscopy. 2009;41:516–21.

    CAS  Article  Google Scholar 

  28. 28.

    Choi YS, Suh JP, Lee DS, et al. Colonoscopy screening for individuals aged 40-49 years with a family history of stomach cancer in Korea. Int J Color Dis. 2010;25:443–7.

    Article  Google Scholar 

  29. 29.

    Chung SJ, Kim YS, Yang SY, et al. Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40-49 years undergoing screening colonoscopy. J Gastroenterol Hepatol. 2010;25:519–25.

    Article  Google Scholar 

  30. 30.

    Thoma MN, Castro F, Golawala M, et al. Detection of colorectal neoplasia by colonoscopy in average-risk patients age 40-49 versus 50-59 years. Dig Dis Sci. 2011;56:1503–8.

    Article  Google Scholar 

  31. 31.

    Ko HJ, Youn CH. Determination of the beginning age for colonoscopic screening among colonoscopy-naïve individuals. Clin Res Hepatol Gastroenterol. 2012;36:384–90.

    Article  Google Scholar 

  32. 32.

    Hemmasi G, Sohrabi M, Zamani F, et al. Prevalence of colorectal adenoma in an average-risk population aged 40-50 versus 50-60 years. Eur J Cancer Prev. 2015;24:386–90.

    Article  Google Scholar 

  33. 33.

    Jung YS, Ryu S, Chang Y, et al. Risk factors for colorectal neoplasia in persons aged 30 to 39 years and 40 to 49 years. Gastrointest Endosc. 2015;81:637–45.

    Article  Google Scholar 

  34. 34.

    Leshno A, Moshkowitz M, David M, et al. Prevalence of colorectal neoplasms in young, average risk individuals: a turning tide between east and west. World J Gastroenterol. 2016;22:7365–72.

    Article  Google Scholar 

  35. 35.

    Park YM, Kim HS, Park JJ, et al. A simple scoring model for advanced colorectal neoplasm in asymptomatic subjects aged 40-49 years. BMC Gastroenterol. 2017;17:7.

    Article  Google Scholar 

  36. 36.

    Wong JCT, Lau JYW, Suen BY, et al. Prevalence, distribution, risk factor for colonic neoplasia in 1133 subjects aged 40-49 undergoing screening colonoscopy. J Gastroenterol Hepatol. 2017;32:92–7.

    Article  Google Scholar 

  37. 37.

    Rosen AB, Schneider EC. Colorectal cancer screening disparities related to obesity and gender. J Gen Intern Med. 2004;19:332–8.

    Article  Google Scholar 

  38. 38.

    Maruthur NM, Bolen S, Gudzune K, et al. Body mass index and colon cancer screening: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev. 2012;21:737–46.

    Article  Google Scholar 

  39. 39.

    Messina CR, Lane DS, Anderson JC. Body mass index and screening for colorectal cancer: gender and attitudinal factors. Cancer Epidemiol. 2012;36:400–8.

    Article  Google Scholar 

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Corresponding author

Correspondence to Mehmet Ali Yerdel.

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Toydemir, T., Özgen, G., Çalıkoğlu, İ. et al. A Comparative Study Evaluating the Incidence of Colorectal Neoplasia(s) in Candidates for Bariatric Surgery by Screening Colonoscopy, 40–49 Versus 50–65 Years Old: a Preliminary Study. OBES SURG 29, 2430–2435 (2019). https://doi.org/10.1007/s11695-019-03819-2

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  • Screening colonoscopy
  • Obese
  • Metabolic syndrome
  • Morbid obesity